NHS England may contribute additional funding to bolster the £3.8bn integration transformation fund announced in the 2013 comprehensive spending review, Sir David Nicholson has said.

However, the NHS England chief executive insisted that, contrary to some expectations, the local pooled budgets set to be created under the plan would not be a “transfer to local government”.

HSJ also understands that the funds may not have to be governed by health and wellbeing boards in all areas, if NHS England or the Department of Health have concerns about an individual board’s capability.

The fund will be worth at least £1bn nationally in 2014-15, and £3.8bn in 2015-16. Most of the funding added in the second year will come from clinical commissioning group budgets. The fund will be used to create pooled budgets for the joint commissioning of health and social care by the NHS and local authorities.

Speaking at the HSJ Commissioning Summit last week, Sir David said that NHS England would consider contributing money from the primary care budget, which it controls, to these pooled funds in each area. He also indicated CCGs could consider contributing more of their own funds than was required.

Combining primary and community care budgets − currently split between NHS England and CCGs − could make it easier to design and contract services that cover both.

Sir David said of the initiative: “It is a very, very, very significant issue. It is not a transfer to local government − this is the development of a pooled budget.”

He said governance of the funds needed to be given further consideration, adding: “I am the accounting officer for this money. I’m not having my successor in a position where they haven’t got satisfactory governance around the £3.8bn.”

It is an indication that NHS England would be willing to veto the supply of funds to particular areas, or to back areas’ proposals for alternative rules.

Sir David described the fund as, “ringfenced for out of hospital care - never have we had that [before]… £2bn gets taken off the acute sector and put into community care”.

Concern about the governance of the funds is shared by some in the NHS who fear that some health and wellbeing boards are not yet well developed and, therefore, are not a good structure for deciding use of the funds.

A statement published by NHS England and the Local Government Association about the integration fund last month said: “Local health and wellbeing boards will sign off the plans, which will have been agreed between the local authority and CCGs.

“The health and wellbeing board is best placed to decide whether the plans are the best for the locality, engaging with local people and bringing a sector led approach to the process. The plans will then go through an assurance process involving NHS England to assure ministers.”


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